| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1999 |
|
4,594 |
3,962 |
$65K |
| D1120 |
Prophylaxis - child |
2,418 |
2,206 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,712 |
2,462 |
$39K |
| 90837 |
Psychotherapy, 53 minutes with patient |
740 |
460 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,396 |
1,256 |
$33K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
290 |
212 |
$30K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
331 |
298 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
364 |
223 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
1,112 |
1,055 |
$16K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
306 |
253 |
$16K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
171 |
130 |
$14K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
214 |
140 |
$10K |
| 99215 |
Prolong outpt/office vis |
79 |
64 |
$7K |
| D0272 |
Bitewings - two radiographic images |
364 |
320 |
$6K |
| D1110 |
Prophylaxis - adult |
98 |
77 |
$4K |
| D1351 |
Sealant - per tooth |
161 |
28 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
167 |
67 |
$2K |
| 90834 |
Psychotherapy, 45 minutes with patient |
46 |
30 |
$2K |
| D0330 |
Panoramic radiographic image |
38 |
37 |
$1K |
| D2140 |
|
28 |
13 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
25 |
17 |
$919.39 |
| D0145 |
Oral evaluation for a patient under three years of age |
31 |
30 |
$423.87 |
| D0220 |
Intraoral - periapical first radiographic image |
30 |
30 |
$256.97 |